The primary-reflex system
A neurological basis for a range of learning difficulties, including reading delay, is suggested by the substantial body of literature linking the persistence of primary-reflexes and learning difficulties1.
Primary-reflexes are movement patterns which emerge during fetal life and are critical for the survival of the newborn, e.g., infant suck reflex. They are readily elicited during the first six months of life2 and primary reflex tests are routinely used by paediatricians to assess the neurological integrity of the newborn baby. As the nervous system develops, however, they are inhibited or transformed and the persistence of primary reflexes beyond their normal timespan (12 months) interferes with subsequent development and indicates neurological impairment3. The persistence of many primary reflexes has a direct bearing on educational functioning and performance.
As the primary system is inhibited or transformed during the first year of life, a secondary (postural) reflex system emerges, providing the reflexive support for movement and balance as the child moves to the upright world of the toddler. The secondary reflex system should remain active throughout adult life.
Emergence, Inhibition and Persistence
The most frequently observed primary-reflex in infants with neurological lesions is the Asymmetrical Tonic Neck Reflex (ATNR)4. It is most obvious in the three months after birth and is elicited by a sideways turning of the head. The response consists of extension of the arm and leg on the side to which the head turns and flexion of the opposing limbs5. In normal development the child starts to transfer objects from one hand to the other across the mid-line from about six months after birth 3. The persistence of an ATNR makes it very difficult for the child to bring both hands together as this requires simultaneous flexion in both arms.
At school, if the child looks towards the hand that is holding the pen/pencil, the ATNR will be stimulated. The arm and hand on that side receives an extensor tonus so that the child may have to employ excessive tension in order to maintain flexion in the fingers. This excess effort may lead to an unusual pencil grip, muscular fatigue and the use of heavy pressure on the page when writing. Further compensatory strategies may involve turning the page ninety degrees towards the other side of the body so that the head is turned towards the arm that is not holding the pen/pencil.
There have been numerous interventions that have sought to approach the sensory, motor and cognitive problems associated with persistent reflexes through the use of movement programmes. Fay6 developed ‘progressive pattern movements’ for working with the brain-injured that sought to recapitulate the phylogenetic development of the human species, while Hollë7 designed movements that tried to stimulate and inhibit reflex patterns. The early work of Karel and Berta Bobath8 stressed the importance of inhibiting reflex patterns; McGlown9 emphasised the importance of replicating the actual reflex movements as a means of inhibiting the underlying persistent reflexes.
A major theme that emerges from movement interventions is the replication of early movement. This suggests that the actual rehearsal and repetition of primary-reflex patterns may play a role in the inhibition process itself- However, interpretations vary as to which reflexes are most important, how to replicate specific reflexes and how reflexes interact with each other. Unfortunately, the evaluations of movement interventions have tended to be either poorly conducted (e.g. no control groups, the use of self reports) or have been found to be ineffective when adequate controls have been used10, 11.
The purpose of our initial research12 was to examine the effects of a specific movement programme on (a) the inhibition of one primary-reflex (the ATNR), and (b) the educational performance of a clearly defined group of children (aged 8-11 years) with reading difficulties and a persistent ATNR, using a randomised, individually matched, double-blind, controlled design. After extensive preliminary work, four movements were selected to make up the ‘experimental movement programme’ based on the tonic labyrinthine reflex, the Moro reflex, the ATNR and the symmetrical tonic neck reflex. One of the movements was developed from the ‘fetal posture’ movement of Raymond Dart13 and another from the ‘fetal movement’ used at the Institute for Neuro-Physiological Psychology, Chester. The other two movements were developed by the writer.
Outset Status of Matched Groups
|Neale Analysis of||Mean||30-2||29.5||31.8|
|Level of ATNR||Mean||3.1||3.1||2.9|
(*months behind chronological age)
Sixty children were randomly assigned to one of three treatment groups after matching for age, sex, verbal IQ, reading ability and level of persistent ATNR. Children in the ‘experimental’ group followed the ‘experimental movement programme’, while children in the placebo group followed non-specific movements. Children in the control group were not given any movements. After a twelve-month period it was found that children in the experimental group had made significant progress relative to the other groups on a number of measures including reduced ATNR persistence, reading level, eye movement control and naming speed (phonological test). There were no significant effects for spelling or ‘spoonerisms’ (phonological test).
Pre- and Post-test Performance: Experimental, Placebo and Control groups on all dependent variables.
|experimental group (N=20)||placebo group (N=20)||control group (N=20)|
|Neale Analysis of Reading Ability (Reading Age, months)||82.90|
|W.O.R.D. (Reading Age, months)||88.65|
|Writing Speed (words per minute)||8.58|
|W.O.R.D. (Spelling Age, months)||95.0|
|(i) Naming Speed (seconds)||58.8|
The results of this study suggest that the repetition of specific primary-reflex movements plays a major role in the inhibition of primary-reflexes and that inhibition can be brought about at a much later stage in development than is generally accepted. The results confirm previous work that the effects of persistent reflexes extend beyond the obvious disruption of motor development into cognitive areas.
It is difficult to provide a detailed model of how the primary-reflex system impinges on the early precursors to reading acquisition, as the teaching of reading begins relatively late in the developmental process (usually at four or five years of age). However, the results of this study suggest that reflex movements play a critical role in early neurological maturation which, in turn, has repercussions for later reading development.
The prevalence of persistent primary-reflexes in children attending ordinary school, and how this relates to academic and other problems, is one of a number of questions currently under investigation. Another important consideration is the long-term efficacy of intervention. Improvements gained by specialised interventions have often proved difficult to sustain or have required long-term intervention that is both labour-intensive and expensive. The robustness of the movement intervention in a school setting is also under investigation.
In conclusion, this study demonstrates the importance of evaluating underlying neurodevelopmental functioning and, in particular, the persistence of primary-reflexes when considering the basis of learning difficulties. This approach could complement cognitive techniques that may not address some of the fundamental neurological prerequisites for educational progress, but it must be stressed that the movement intervention programme is not an alternative to teaching methods.